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General NPI Number Information
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NPI Number | 1578664066
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Entity Type | Organization
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Legal Business Name | FREMONT COUNTY PEDIATRIC CLINIC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 115 WYOMING ST
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City | LANDER
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State | WY
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Zip | 82520-3919
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Country | US
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Telephone | 307-332-2185
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Fax | 307-332-7799
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Provider Business Mailing Address
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Address Line | 115 WYOMING ST
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City | LANDER
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State | WY
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Zip | 82520-3919
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Country | US
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Telephone | 307-332-2185
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Fax | 307-332-7799
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD E. BARNES
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Credential | M.D.
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Telephone | 307-332-2185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 5774A
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License Number State | WY
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